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  • Approximately 265 million American have prescription benefits serviced by Pharmacy Benefit Managers (PBMs). The PBMs service these Americans through Medicare Part D, Managed Medicaid, and private/commercial insurance. The goal of the PBMs is to reduce the rising cost of prescription benefits while increasing the amount of access to prescription medications. This is a tall order to fill. Pharmacy Benefit Managers look to reduce costs by focusing primarily on six categories.

    Increased Use of Generic Medicine

    PBMs look to encourage the use of generic and preferred brands. Generics usually come at a significantly reduced cost vs. the price of brand name drugs. PBMs look to increase the awareness of the preferred drugs and generic options through consumer education and bringing these specific drugs to the attention of physicians who prescribe medications for their patients.

    Discounts with Pharmacies

    Plans are formulated where specific pharmacies offer to fill prescriptions at a reduced rate. This benefits the pharmacy because consumers will go to these stores to receive their prescriptions which in turn can increase the profits and foot traffic of the contracted pharmacies.

    Getting Patients to Take Prescriptions Correctly

    One increase in cost to prescription drugs comes from patients not taking their medication correctly. They can either take too much or not enough of the drug they were prescribed, and this can bring the need for additional care or a longer term use of  prescription medication.

    Rebates from Drug Manufacturers

    When a brand-name drug is the preferred drug, rebates can be offered so that the preferred drug is chosen more than the competition. This can be facilitated  by offering a reduced copay if that particular drug is chosen.

    Increased Ways of Receiving Prescriptions

    Instead of just offering prescriptions through a pharmacy, prescriptions can be made available through mail and specialty channels. This offers reduced costs to patients and can put more emphasis on preferred brands.

    Handling of Specialty Medication

    Medications for cancer and other complex ailments can cost thousands of dollars per dose. The proper storing and handling of this medication, along with increasing patient awareness and proper use can reduce mishandling and waste which can bring down the overall cost in the lifecycle of these medications.

    Implementing these tools can save billions of dollars for consumers and commercial sponsors. The savings will vary depending upon how many of the tools are used and how well each tool is utilized. Northwood has a national pharmacy network of over 55,000 providers and is an expert in catastrophic claims. Northwood ensures insurance carriers and claimants have access to quality pharmacy service providers with discounted rates.

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